The Riverview Hospital Decentralization Study captured a rare moment in time in Canadian mental health history.
The study documented the closure of Riverview Hospital (RVH) and evaluating the implications of decentralizing psychiatric services in British Columbia (BC).
This study is unique from some of the other projects that are examining former RVH patients because it examined patients’ strengths and risks, documented changes in dynamic, treatment-friendly variables, and examined positive and negative outcomes across multiple domains. The researchers had funding to track the impact of decentralization of patients and clinical services every 3 months over a one-year-period, which began in 2007. Ultimately, the goal is to follow-up the patients annually for several years, thus evaluating the short-term and long-term implications of the restructuring of services.
The study focused on the recent former patients at Riverview Hospital as they underwent the transition to tertiary regional psychiatric facilities within the community. Through file reviews and patient interviews, the study captured the
baseline mental health status and well-being of patients who were transferred from RVH. Researchers have documented possible therapeutic improvements, changes in quality of life and details about adverse incidents (e.g. suicide, self-harm, victimization, violence) by conducting follow-up assessments with patients every 3 months for one year. In addition, researchers also collected relevant supplementary information by examining official databases and by interviewing staff and family members.
The principal investigator, Dr. Tonia Nicholls, Senior Research Fellow at BC Mental Health & Substance Use Services (BCMHSUS), has a PhD in psychology with specialized training in forensic psychology and the law. The study is a collaboration between clinicians (Drs. Soma Ganesan, Johann Brink), senior administrators (Leslie Arnold, Patrick Smith, Peter Coleridge, Lynda Bond), and researchers from BCMHSUS (RVH and the Forensic Psychiatric Hospital), SFU, and UBC. This partnership between researchers and decision-makers at BCMHSUS and within the Provincial Health Services Authority (PHSA) will help to ensure that the study is relevant to patients and that it provides empirical evidence that will inform evidence-based practice.
Patients were asked to take part in a series of 5 interviews. The baseline interview took place at RVH before the patient left; the others took place in tertiary regional psychiatric facilities within the community. Participants were also asked to grant the researchers access to their files and official records and to seek the approval of a family member or friend who was willing to take part in the study. Over the course of the study, research assistants accessed files, interview rooms and required some staff assistance (e.g. arranging interviews). In order to obtain supplementary details on patients’ mental health and behaviours over the last few months, staff were also asked to participate in brief interviews.
By documenting the practical, clinical, and social implications of this restructuring of health care delivery, this research will capture a rare moment in Canadian mental health history. In addition, this study will have broad implications for the immediate future of mental health care delivery in BC and may further establish the PHSA as a leading organization in health care delivery.
Riverview Hospital (RVH), British Columbia’s only large scale psychiatric hospital closed in the summer of 2012. Several research projects were conducted evaluating the impact of the hospital closure on patients. Many aspects of patient care and well-being were considered as well as negative outcomes such as homelessness and relocation to correctional facilities. Research to date has shown that patients' symptoms remained stable after they moved out of RVH. Patients also experienced improved quality of life and improvements in daily living skills (Petersen, Nicholls et al., in press). In addition, less than 0.5% of patients who left RVH experienced what is often referred to as transinstitionalization (i.e., shifting care to a correctional facility such as a jail or prison, being admitted to the Forensic Psychiatric Hospital) and / or experienced brief periods of homelessness (Petersen, Nicholls et al, in press; Livingston, Nicholls, & Brink, 2010). In summary, preliminary findings suggest that a well-planned and well-financed hospital closure can avoid many of the negative outcomes often assumed to be associated with psychiatric bed / hospital closures, and lead to some positive outcomes such as improved quality of life for patients. Our study will continue to examine if these outcomes hold out over the longer term.